September 6-12: National Suicide Prevention Week

Margo Kerrigan, M.P.H., Area DirectorIndian Health Service California Area Office

The goal of Suicide Prevention Week is to promote awareness and advocacy about suicide prevention. Suicide is a major concern across the United States, and a problem of tragic proportions in Indian communities. In the United States, more than 30,000 people die by suicide each year1. According to the Centers for Disease Control, the suicide rate for American Indians and Alaska Natives is over twice the national average for all races. It is the second leading cause of death [behind unintentional injuries and accidents] for Indian youths aged 15 to 24. Ninety percent of people who die by suicide have a diagnosable mental illness and/or substance abuse disorder.2

Suicide impacts individuals, families, peers, community, and larger society. Each time a young person takes his or her life it dramatically affects the lives of at least six to eight other significant individuals, often with permanent consequences to productivity, self-esteem, or physical or mental health.3 In fact, there are higher rates of suicide among survivors (i.e., family members and friends of a loved one who died by suicide].4 The risk of "cluster" suicide increases in communities that are closely linked to each other.

Facts about Suicide:

1. Suicide is preventable. Most suicidal individuals desperately want to live but are unable to see alternatives to their problems.
2. Most suicidal individuals give definite warnings of their suicidal intentions, but others are either unaware of the significance of these warnings or do not know how to respond to them.
3. Talking about suicide does not cause someone to be suicidal.
4. Four times as many men kill themselves as compared to women, yet three times as many women attempt suicide as compared to men.
5. Suicide occurs among people of all ages, ethnicities, and economic and social classes.
6. Firearms are currently the most utilized method of suicide by virtually all groups [male, female, young, old, white, non-white].
7. Surviving family members not only suffer the trauma of losing a loved one to suicide, and may themselves be at higher risk for suicide and emotional problems.5

The Link between Depression and Suicide:

Depression can interfere with ones ability to function in all areas of life [work, family, sleep, etc]. Common symptoms of depression occur almost every day for a period of two weeks or more:
1. Depressed mood [e.g. feeling sad or empty]
2. Lack of interest in previously enjoyable activities
3. Significant weight loss or gain, or decrease or increase in appetite
4. Insomnia or hypersomnia
5. Agitation, restlessness, irritability
6. Fatigue or loss of energy
7. Feelings of worthlessness, hopelessness, guilt
8. Inability to think or concentrate, or indecisiveness
9. Recurrent thoughts of death, recurrent suicidal ideation, suicide attempt or plan for completing suicide

Major Depressive Disorder [MDD] is the psychiatric diagnosis most commonly associated with completed suicide. About 2 out of 3 of people who complete suicide are depressed at the time of their deaths. About 7 out of every 100 men and 1 out of every 100 women who have been diagnosed with depression at some time in their lifetime will go on to complete suicide. People who have a dependence on alcohol or drugs in addition to being depressed are at greater risk for suicide. The best treatment for depression is the combination of antidepressants and psychotherapy. Treatments are effective 60 to 80 of the time.

Understanding and Helping the Suicidal Individual: Be Aware of the Warning Signs

Are you or someone you love at risk of suicide? Get the facts and take appropriate action. Get help immediately by contacting a mental health professional or calling the National Suicide Prevention Lifeline [1-800-273-8255] for a referral should you witness, hear, or see anyone exhibiting any one or more of the following:
1. Someone threatening to hurt or kill him/herself, or talking of wanting to hurt or kill him/herself.
2. Someone looking for ways to kill him/herself by seeking access to firearms, available pills, or other means.
3. Someone talking or writing about death, dying or suicide, when these actions are out of the ordinary for the person.

Seek help as soon as possible by contacting a mental health professional or calling the National Suicide Prevention Lifeline [1-800-273-8255] for a referral should you witness, hear, or see anyone exhibiting any one or more of the following:
1. Hopelessness
2. Rage, uncontrolled anger, seeking revenge
3. Acting reckless or engaging in risky activities, seemingly without thinking
4. Feeling trapped - like theres no way out
5. Increased alcohol or drug use
6. Withdrawing from friends, family and society
7. Anxiety, agitation, unable to sleep or sleeping all the time
8. Dramatic mood changes
9. No reason for living; no sense of purpose in life

Understanding and Helping Surviving Relatives and Friends

The loss of a loved one by suicide is often shocking, painful and unexpected. The grief that ensues can be intense, complex, and long term. Grief is an extremely individual and unique process; each person will experience it in their own way and at their own pace. There is no time frame for grief. Survivors should not expect that their lives will return to their prior state. Common emotions experienced in grief are shock, denial, pain, guilt, anger, shame, despair, disbelief, hopelessness, stress, sadness, numbness, rejection, loneliness, abandonment, confusion, self-blame, helplessness, and depression. These feelings are normal reactions and the expression of them is a natural part of grieving. At first, and periodically during the following days/months of grieving, survivors may feel overwhelmed by their emotions. It is important to take things one day at a time. Crying is the expression of sadness; it is therefore a natural reaction after the loss of a loved one.

There is a stigma attached to suicide, partly due to the misunderstanding surrounding it. Shame or embarrassment might prevent the survivor from reaching out for help. Stigma, ignorance and uncertainty might prevent others from giving the necessary support and understanding. Ongoing support remains important to maintain family and friendship relations during the grieving process. When the time is right, survivors will begin to enjoy life again. Healing does occur. Many survivors find that the best help comes from attending a support group for survivors of suicide where they can openly share their own story and their feelings with fellow survivors without pressure or fear of judgment and shame.

Children as Survivors
It is a myth that children dont grieve. Children may experience the same range of feelings as do adults; the expression of that grief might be different as children have fewer tools for communicating their feelings. Children are especially vulnerable to feelings of guilt and abandonment. It is important for them to know that the death was not their fault and that someone is there to take care of them. Secrecy about the suicide in the hopes of protecting children may cause further complications. Explain the situation and answer childrens questions honestly and with age-appropriate responses.

Indian Health Service
Indian Health Service [IHS] continues to measure and improve the quality of healthcare for American Indians and Alaska Natives through the Government Performance and Results Act [GPRA], which requires Federal agencies to demonstrate that they are using their funds effectively toward meeting their missions. IHS recognizes the importance of screening for depression and that surveillance, data collection and data analysis are integral components of a comprehensive community or public health agency response to suicide. IHS has established depression screening and suicide reporting as GPRA measures. In FY 2006, 15 of all adults age 18 and up were screened for depression at reporting IHS and tribal facilities nationally; in California, the screening rate was 14.